1997 research outputs found
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A Retrospective Cross-Sectional Analysis of Asthma, Hypertension and Diabetes Emergency Encounters; New Insights for Community Health Needs Assessments
No full textCommunity Health Needs Assessments and the developed strategies corresponding to any findings provide opportunities to improve the health of communities by targeted, coordinated efforts to meet the community needs. Thomas Jefferson University Hospital’s 2016 Community Health Needs Assessment utilized numerous data sources yet found data gaps pertaining to the health status of immigrant populations due to limitations of surveying methods. Large amounts of electronic patient-specific information are generated, exchanged, and stored as “big data” in health information exchanges. The Greater Philadelphia region uses the HealthShare Exchange, the regional HIE, as a community asset to facilitate this data transfer. The HealthShare Exchange provides a Clinical Database Repository (CDR), which was used for this study to (1) identify rates and possible disparities of asthma, hypertension, and diabetes among emergency encounters in Philadelphia and (2) assess the utility of the CDR for Community Health Needs Assessments. There were significant disparities identified between race/ ethnicities, genders (asthma and hypertension only), and geographic regions for these diagnoses. With the future acquisition of primary health facility data and subsequent to further validity testing, the HealthShare Exchange’s Clinical Database Repository shows promise in identifying disparities for future needs assessments and targeted intervention
COPD Exacerbations in Nursing Homes: A Retrospective Chart Review
No full textIntroduction: OPTIMISTIC is a project funded by the Centers for Medicaid and Medicare Services (CMS) that is aimed, in part, at the reduction of unnecessary hospitalization of nursing facility residents. Data from the initial phase of the project indicated that 11% of resident potentially avoidable hospitalizations were associated with a diagnosis of COPD. Avoidable hospital transfer of long-term stay nursing home residents carries both a large financial burden and a poor prognosis, making avoidance essential to care. Objective: This retrospective chart review has the goal of analyzing and describing the diagnosis, treatment strategies, and outcomes for nursing home patients treated for an exacerbation of COPD in OPTIMISTIC facilities. Methods: A list of all patients from OPTIMISTIC facilities that billed CMS for the diag-nosis of a COPD Exacerbation from 11/1/2017 to 6/1/2019 was obtained, the top 6 highest billing facilities were selected, and 3 patient charts from each facility were se-lected at random. This yielded 18 individual patient records, with 2 patients having multiple billing episodes within the time period, for a total of 23 episodes. A standard-ized data collection tool was used to collect information from both online electronic medical records and paper charts. The data tool included demographics, patient medical history, COPD staging and treatment, diagnostic data, treatment facts, and out-comes. All data was stored without patient identifiers, under password protection. Results: The mean age of patients was 82 years (n=18), and the percentage of patients suffering from an exacerbation and/or all cause hospitalization within one year of their certification were both 39% (n=7). 70% (n=16) of patients were certified by the provider within 2 days. In 78% (n=18) of cases, patients were able to recover to their prior condition within the facility, while only 9% (n=2) required the patient be transferred to the hospital. Providers ordered inhaled bronchodilators in 96% (n=22) of cases, antibiotics in 70% (n=16), and oral Prednisone in 78% (n=18) of cases. OPTIMISTIC certification criteria were met in 87% (n=20) of cases. Conclusions: Given the disease state, comorbidities, history, and age of this population, many are high-risk COPD patients. This chart review demonstrated efficacy of the OPTIMISTIC care model for in-house recovery of residents in an acute exacerbation of COPD. Patients were diagnosed and treated rapidly in a large majority of cases. Treatment strategies and choices aligned reasonably well with OPTIMISTIC evidence-based treatment protocols. Only one patient was not prescribed an inhaled bronchodilator, and most patients were given some course of oral prednisone, both of which are indicated in the treatment of an acute COPD exacerbation. Results indicated relatively low use of antibiotic therapy, but varied antibiotic usage of multiple classes, supporting the need for continued vigilance in antibiotic stewardship
Perceptions of interprofessional education in the medical and nursing curriculums
No full textInterprofessional education or IPE involves bringing individuals from two or more professions together to learn and communicate to improve future teamwork and collaboration. IPE research has shown that exposing future healthcare professionals to interprofessional training results in positive patient outcomes and reduced institutional costs. Our study will be a case based interprofessional simulation between Marian University nursing and medical students. The goals of our study include: 1) evaluating the perceptions of interprofessional education among nursing and medical students and 2) examining whether there are beneficial areas to overlap the nursing and medical training curriculums to implement effective IPE opportunities. The study will be conducted on January 22, 2020 in the Simulation Center at MU-COM, under the direction of David Patterson. Participants will be recruited via flyers and email communication. Incentivization could include using Amazon gift cards, funded via research funds available to BMS graduate students. Prior to the simulation, participants will be asked to complete an online module via Canvas. The module will pertain to the case, include anonymous demographics questions, as well as, a pre-survey. The Interdisciplinary Education Perception Scale (IEPS) survey will be used for pre and post simulation. Each participant will randomly be assigned a simulation team, balancing nursing students with medical students. On simulation day, participants will undergo a brief introduction/orientation to the required equipment. Once they are oriented to their surroundings they will work through the case as a team. The chosen case, which involves women’s reproductive health, will require students to not only use their clinical skills to treat the patient, but will also require them to handle a religious social aspect that will affect the available treatment options. When the teams have come to a conclusion with the case, they will enter a small conference room to undergo a debriefing session where facilitators, including both nursing and medical school faculty, will help them analyze their use of communication during the simulation. After this short discussion, participants will again take the IEPS survey, as well as provide feedback on the simulation.In the post-simulation analysis, we will compare pre-survey scores with post-survey scores and compare how perceptions of interprofessional education have changed. We believe that perceptions of IPE will improve from pre-simulation to post-simulation and that the participants will feel better prepared for future collaboration
The Unbinding
No full textThe Unbinding chronicles a woman\u27s experience of finding her way through and out of a twenty-year marriage rooted in domestic violence, as well as her continued unbinding from trauma. The abuse she survives is particularly insidious due to the fact that she is married to a pastor, and thus it includes not just emotional, psychological, physical, and sexual abuse, but also spiritual abuse. Settings and images of everyday life provide a gateway into a remarkable journey, the telling of which is vivid and dark, yet ultimately hopeful. The woman at the center of this journey survives due to her children - a manifestation of her grace in the world - and her grit
Morgan Jones
Get PDFHailey describes the mentoring she benefited from in knowing Morgan Jones, assistant tennis coach during her time in high school. In particular, she describes the maturation of decision-making he has experienced throughout his life, and reflects upon it for her path forward
Endothelial RhoA GTPase is essential for in vitro endothelial functions but dispensable for physiological in vivo angiogenesis.
No full textImbalanced angiogenesis is a characteristic of several diseases. Rho GTPases regulate multiple cellular processes, such as cytoskeletal rearrangement, cell movement, microtubule dynamics, signal transduction and gene expression. Among the Rho GTPases, RhoA, Rac1 and Cdc42 are best characterized. The role of endothelial Rac1 and Cdc42 in embryonic development and retinal angiogenesis has been studied, however the role of endothelial RhoA is yet to be explored. Here, we aimed to identify the role of endothelial RhoA in endothelial cell functions, in embryonic and retinal development and explored compensatory mechanisms. In vitro, RhoA is involved in cell proliferation, migration and tube formation, triggered by the angiogenesis inducers Vascular Endothelial Growth Factor (VEGF) and Sphingosine-1 Phosphate (S1P). In vivo, through constitutive and inducible endothelial RhoA deficiency we tested the role of endothelial RhoA in embryonic development and retinal angiogenesis. Constitutive endothelial RhoA deficiency, although decreased survival, was not detrimental for embryonic development, while inducible endothelial RhoA deficiency presented only mild deficiencies in the retina. The redundant role of RhoA in vivo can be attributed to potential differences in the signaling cues regulating angiogenesis in physiological versus pathological conditions and to the alternative compensatory mechanisms that may be present in the in vivo setting
Keynote - The Case for Inclusive Teaching
Get PDFThe keynote speaker, Kevin Gannon, facilitated an interactive workshop during which participants were introduced to the research supporting Inclusive Pedagogy and encouraged to see it as a crucial part of our mission from the institutional to the individual course level. He discussed how course design and classroom pedagogy fit into this paradigm, and examined some concrete strategies to inform inclusive teaching
Nusinersin Does Not Mitigate Hip and Spine Pathoanatomy in Spinal Muscular Atrophy Patients
No full textSpinal muscular atrophy (SMA) consists of a group of neuromuscular disorders characterized by degeneration of alpha motor neurons, leading to a lower motor neuron-type syndrome. Children afflicted with SMA 1 and 2 are prone to abnormal musculoskeletal growth and deformities affecting axial/appendicular skeleton. Nusinersin is an antisense oligonucleotide therapy administered intrathecally for the duration of the patient’s life with proven benefits of partially maintained muscle strength and respiratory function. The effect of Nusinersin to mitigate developing skeletal deformities, namely the occurrence and progression of scoliosis and hip instability (coxa valgus, acetabular dysplasia) has not been evaluated. We hypothesize SMA patients receiving Nusinersin treatment will have lower incidence/progression of scoliosis and hip instability, less need for surgical correction in proportion to age/motor growth remaining at the time therapy was initiated, compared to similar cohort not treated w/ Nusinersin. 44 subjects with SMA2 were analyzed with a median age at baseline of 4.2 years (range, 1.3-23.9 yrs) and were followed for a median of 7.0 yrs (range, 1.2-14.5 yrs) to a median age of 11.7 yrs (range, 4.1-36.3 yrs). 22 subjects (43%) were treated with Nusinersin for a minimum of 1 year (median 2.2 yrs; range, 1-6.6 yrs). Consecutive radiographs were measured to document the presence/progression of scoliosis and hip instability using Cobb and Migration Index respectively. Established pathoanatomic thresholds for recommending surgical intervention of spine/hip were used to assess failure of Nusinersin. Subjects in Nusinersen group were younger (median, 2.5 vs 6.8 yrs; p=0.001) and had smaller curves at baseline (median, 11° vs 20°; p=0.02). 13/23 subjects untreated with Nusinersen without respiratory assist at baseline, required respiratory assistance at end of follow-up (p\u3c0.001). 9/17 Nusinersen subjects without respiratory assist at baseline, required it at the end of follow-up (p=0.008). No difference in scoliosis progression between pre- vs post-Nusinersen treatment in absolute change (p=0.54) or annual change in Cobb angle (p=0.57). No difference in scoliosis progression between treated vs. untreated SMA patients at any point during follow-up with respect to absolute change (p=0.15) or annual change in Cobb angle (p=0.23). Of 19 patients treated w/ Nusinersen, 15 had serial hip radiographs and of 25 untreated subjects, 11 had serial hip radiographs. All SMA patients had significant hip instability regardless of treatment. Patients with SMA benefit from improved muscle strength in proportion to the neuromotor growth remaining at the time treatment is instituted, treatment with Nusinersin did not ameliorate the skeletal manifestations: scoliosis, parasol rib deformity, hip instability progressed independent of the age that treatment was instituted
Importance of fatty acid binding protein 4 (FABP4) during Coxiella burnetti intracellular growth in alveolar macrophages
No full textCoxiella burnetti is an obligate intracellular bacterial pathogen that spreads to humans via inhalation, infects alveolar macrophages and causes the worldwide zoonosis known as Q fever. Acutely, Coxiella infection manifests as a mild flu-like illness. However, chronic disease presents as endocarditis which is fatal if untreated. It is often clinically undetected until as many as 20 years post-infection suggesting Coxiella’s ability to manipulate host cell processes to establish long-term survival. Although Coxiella initial-ly infects alveolar macrophages, in endocarditis patients it is found in lipid droplet (LD)-rich foam cells. Our previous studies demonstrate that Coxiella manipulates host lipid storage organelle LD accumulation by releasing bacterial effector proteins via its major virulence factor Type 4 secretion system (T4SS). Further, manipulation of host cell LD homeostasis significantly alters Coxiella intracellular growth suggesting the importance of LDs during Coxiella infection. Our overall goal is to identify host cell proteins Coxiella targets to manipulate host cell LD metabolism. Fatty acid binding protein 4 (FABP4) is a cytoplasmic fatty acid chaperone expressed primarily in adipocytes and macrophag-es. It regulates intracellular lipid accumulation and plays an important role in foam cell formation during atherosclerosis. Since LD metabolism plays an essential role during Coxiella pathogenesis, we hypothesize that Coxiella manipulates FABP4 to promote LD accumulation in Coxiella-infected cells. To address this, we performed quantitative Real Time PCR (qRT-PCR) to determine Fabp4 expression in Coxiella-infected alveo-lar macrophages. Compared to uninfected cells, Fabp4 gene expression significantly increased in Coxiella-infected cells suggesting its importance during bacterial infection of alveolar macrophages. Ongoing studies are determining if Coxiella actively manipu-lates FABP4 gene expression via T4SS effectors. Future studies will identify the role of FABP4 in LD accumulation in Coxiella-infected alveolar macrophages and measure bacterial growth in Fabp4-/- alveolar macrophages
Characterization of PPAR receptor activation by Troglitazone, a PPAR agonist
No full textTroglitazone (TRO), a peroxisome proliferator-activated receptor (PPAR) agonist, was a drug used as an anti-inflammatory and anti-diabetic agent. We had previously investigated a PPAR agonist that induced apoptosis in dose dependent manner in our human colorectal cell line HCT116. Our current experiments are designed to determine if TRO is able to induce apoptosis, and if this action is mediated through the PPAR receptor subtypes. PPARɣ specifically is a known member of the steroid receptor superfamily and is a ligand-activated nuclear transcription factor that regulates lipid and glucose homeostasis. As a PPARɣ activator, TRO, a thiazolidinedione, has been shown to have the effect of inducing cell differentiation but also inhibiting cell growth, proliferation, and angiogenesis thereby facilitating apoptosis, making it a potential candidate to study as a cancer chemotherapeutic agent. Through the use of flow cytometry, TRO-induced apoptosis of tissue culture grown colorectal cancer cells was examined. Apoptosis was quantified by analyzing cells that contain less than the 2N DNA content (one hallmark of apoptosis). A dose response curve was determined for increasing concentrations of TRO vs sub2N DNA content. These studies confirm that TRO was able to induce apoptosis in our cell lines at concentrations greater than 30 M. Next we wanted to determine which PPAR receptors subtypes are being activated by TRO. HCT116 cells were exposed to various concentrations of TRO for 24hr then RNA was isolated from these cells. Specific gene targets to each PPAR receptor subtype were identified and using RT-PCR, changes in mRNAs expression was examined. Targets PPAR were consistently induced, PPAR were not induced, and PPAR were inconsistently induced. We are working to refine these experiments to get better determinations on which receptors are activated by TRO. These experiments confirm that TRO induces apoptosis in HCT116 cells. Additionally, we have identified changes in at least one target of PPAR receptors in response to TRO exposure. Further experiments are needed to exactly determine which PPAR receptors are being activated by TRO, and whether the apoptosis medicated by TRO is a result of PPAR receptor activation